| NPI | 1013989029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD D0070404) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E3821) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2018-05-19 |